April 20, 2016 | | JFAS | Contact Us

News From ACFAS

Prepare Your Manuscript for ACFAS 2017
Our milestone 75th Anniversary Scientific Conference calls for time-honored traditions that reflect on the past and offer us a glimpse into the future. Each year, the Manuscript Competition does just that by giving foot and ankle medical researchers the opportunity to share their latest findings.

Submissions for the Manuscript Competition at ACFAS 2017 in Las Vegas are due August 1, 2016. All manuscripts submitted for consideration will be blind-reviewed and judged on established criteria. Winners will divide $10,000 in prize money.

Check after June 1 for manuscript requirements and submission details.
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Take a New Look at Surgical Coding
Register now for our new Coding & Practice Management Workshop and see the coding and billing process in an entirely different light. Join us in Denver (July 8–9) or Chicago (October 21–22) where expert faculty will dispel common coding myths and share fresh perspectives on:
  • CPT coding and documentation
  • evaluation and management surgical codes
  • common podiatry modifiers
  • new government reimbursement systems and methods
This interactive seminar devotes six full hours of lecture time to surgical coding and also gives you the opportunity to code a sample patient encounter.

Visit today for details and to register.
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Stay Ahead of the Research Curve with April SLRs
New developments in foot and ankle surgery happen quickly and often. Keep up with the latest research by reading this month’s Scientific Literature Reviews (SLRs) on

Written by podiatric surgical residents, SLRs summarize studies from other scientific specialty journals. Our April reviews cover clubfoot, mesenchymal stem cells, risk factors for thromboembolic events after ankle fracture surgery and more.

Visit monthly for new reviews and never fall behind on the research that may affect your surgical cases.
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Foot and Ankle Surgery

Evaluation of Elastic Stiffness in Healing Achilles Tendon After Surgical Repair of a Tendon Rupture Using In Vivo Ultrasound Shear Wave Elastography
A recent study looked at the effect of using shear wave elastography (SWE) to assess repair of the Achilles tendon. Researchers analyzed the changes in mechanical properties of the tendon and how they related to function. Twenty-six patients underwent the procedure, and elasticity values were measured at 12, 24 and 48 weeks postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to rate functional outcomes. Elasticity measures and AOFAS scores differed significantly across the three follow-up periods. Tendon function was positively correlated with the elasticity of the repaired Achilles tendon, leading researchers to conclude that SWE is a viable option for learning biomechanical information to evaluate the healing Achilles.

From the article of the same title
Medical Science Monitor (04/09/16) Zhang, Li-ning; Wan, Wen-bo; Wang, Yue-xiang; et al.
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Functional Outcomes Following First Metatarsophalangeal Arthrodesis
A recent study evaluated the functional outcomes of a series of patients undergoing first metatarsophalangeal (MTP) joint arthrodesis for arthritis. Researchers looked at 53 patients treated with either a plate and screw or independent screw construct. Successful fusion was defined as no lucency at the first MTP joint and bridging of two or more cortices on the anteroposterior, lateral and oblique radiographic views at final follow-up. Ability to complete daily activities following treatment was also examined. Difficulty performing daily activities significantly decreased, and all Foot and Ankle Outcome Scores and SF-36 scores improved as well. The majority of patients reported satisfaction with the procedure. The greatest functional improvements were seen in ability to walk distances and perform low-impact sports activity, leading the researchers to identify first MTP joint arthrodesis as a viable and successful treatment.

From the article of the same title
Foot & Ankle International (04/16) DeSandis, Bridget; Pino, Alejandro; Levine, David S.; et al.
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New Concurrent Surgery Guidelines Receive Mixed Reviews
The American College of Surgeons' new guidelines on concurrent surgeries are drawing mixed reviews. The practice of concurrent surgeries has come into question of late, and the new standards look to bar surgeons from double-booking cases in such a way that "critical or key" parts of the surgeries overlap. The guidelines also require surgeons to notify patients when they will be conducting simultaneous procedures. While some experts say the rules are a "wake-up call," others are not so sure. Critics believe that Medicare's billing rules already encompass many of the proposed changes, including the requirement to inform patients and the restriction on overlapping key parts of procedures. These critics think the guidelines are a half measure that do not go far enough.

From the article of the same title
Fierce Practice Management (04/14/16) Kuhrt, Matt
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Practice Management

4 Low-Cost Ways to Motivate Your Practice's Employees
Every practice must deal with unmotivated employees at some point, which can slow productivity, lower profits and decrease morale and patient satisfaction. Boosting motivation, meanwhile, can increase productivity and be cost-effective. If your staff feels that you value them, they will be more motivated and will work harder. Here are four cost-effective strategies to motivate your employees:
  1. Ask questions … and listen to the answers. Asking questions shows your staff that you appreciate and value their opinions. Listening and responding to their answers is just as important. It shows you care, and it could help you learn more about your employees.
  2. Challenge your staff. Offer opportunities to learn new skills. Reshuffle job duties every so often. Assign certain qualified staff to higher-level projects. High performers may benefit the most because they are likely to become bored more quickly.
  3. Acknowledge milestones. Employment anniversaries, birthdays and family events are important to your workers, so they should be important to you as well. Be careful, though: do not show favoritism as this could alienate some employees.
  4. Set a good example. Employees will follow a leader who demonstrates engagement and passion. Demonstrate your expectations and inspire your employees to follow your lead.
From the article of the same title
HCPLive (04/11/16) Gray, Ryan
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Living with Malware: How to Become 'Intrusion-Tolerant'
Healthcare organizations must learn to live with the reality of malware and cyberattacks, according to medical device cybersecurity expert Kevin Fu. It will take time for new device upgrades to reach the marketplace, so hospitals must press vendors to provide more meaningful security. Fu believes this security should be measurable. He also says all health organizations should 1) conduct a risk assessment to determine exposure to cybersecurity risks; 2) apply appropriate compensating controls. If a certain device has known vulnerabilities, do not hook it up to the Internet; and 3) continuously measure the effectiveness of security controls. "Security is not a product; it's more of a property. Just like you can't buy an ounce of safety, you can't buy an ounce of security to sprinkle onto your clinical systems," Fu said.

From the article of the same title
Healthcare Info Security (04/11/16) McGee, Marianne Kolbasuk
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Health Policy and Reimbursement

Can Fixed Payments Transform the Healthcare Industry?
New Medicare pilot programs are testing the efficiency of fixed payments for surgeries and their effect on care. UnityPoint Health-Meriter, in Madison, Wisconsin, has participated in several of these programs and has emerged with promising results. Hospital readmissions within 90 days dropped by 50 percent. The percentage of patients admitted to a nursing home or rehab after surgery fell from 65 percent to 36 percent. Overall, costs were cut by 11 percent. These figures could save billions of dollars if replicated throughout the nation's healthcare system. Medicare alone spent more than $7 billion just for hospital care in 2014. With bundled payments, these figures fell because hospitals, doctors and other providers now had a financial incentive to put in the hours to find ways to lower costs and improve quality. Medicare is now forcing the change in Milwaukee and Madison and could implement similar moves around the country in the future.

From the article of the same title
Milwaukee-Wisconsin Journal Sentinel (04/16/2016) Boulton, Guy
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HHS Report: Dire Warnings of ObamaCare Price Spikes Wrong
The U.S. Department of Health and Human Services (HHS) has released a report showing that Affordable Care Act (ACA) premiums rose eight percent on average last year, quelling fears that the premiums would spike by double-digit percentages. For many consumers, the average increase premium was even smaller, around four percent. Some insurers spiked premiums by double-digits, but those numbers are not nationally representative because consumers can often switch to a different plan so they need not pay the increase. The report’s timing comes as insurers are preparing to file their proposed premium rates for the ACA marketplaces next year, a period that often sets off warnings about price spikes. HHS said the report "debunks the myth" of high premium increases, although there are still potential warning signs for the coming year. Some insurers have discussed dropping off the ACA marketplaces because of financial losses. UnitedHealth has already announced it will drop out of the marketplaces in Georgia and Arkansas, and more states could follow suit.

From the article of the same title
The Hill (04/12/16) Sullivan, Peter
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ICD-10: Payers Stepping Ahead of CMS by Demanding Greater Specificity in Claims
Some commercial health insurance companies are calling for greater specificity for ICD-10 claims, and many experts predict a large spike in denials because many practices may not comply. The Centers for Medicare and Medicaid Services announced that it will accept and process claims as long as they are submitted in the correct ICD-10 family of codes until October 1, 2016. Before then, healthcare organizations must prepare for the change. The first step is proper training. Physicians must be made aware of the higher level of specificity needed in claims. This process can be time-consuming and frustrating, especially because many doctors did not believe ICD-10 would ever really happen. After training, it is important to phase out doctors' ICD-9 charge sheets. For many organizations, all of these moves will not be difficult. But even minor conflicts between ICD-9 and ICD-10 could interrupt a revenue cycle.

From the article of the same title
Healthcare IT News (04/12/16) Andrews, John
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Patients' Hospital Ratings May Predict Care Quality
A new study has found that patient-assigned hospital star ratings correspond with the quality of the hospitals' patient outcomes. Researchers looked at more than 3,000 hospitals' Centers for Medicare and Medicaid Services ratings. The data included 125 five-star ratings, 806 four-star ratings, more than 1,400 with three stars, 623 with two stars and 76 with one. These ratings were found to be inversely proportional to their rates of death within a month of discharge. Five-star hospitals also had lower readmission rates (under 20 percent) while every other star rating readmitted at least 20 percent. "If you use the star rating, you're more likely to end up at a high-quality hospital," co-author Ashish K. Jha. Experts do not put too much stock into the hospital rating system, which has proven to be controversial. Smaller rural hospitals “select” less acute patients, said Dr. Joshua J. Fenton of the University of California, Davis. The authors of the new study tried to account for that, but it may still have affected the results.

From the article of the same title
Fierce Healthcare (04/13/2016) Budryk, Zack
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Sales of Short-Term Health Policies Surge
Sales of short-term health insurance have increased sharply since the Affordable Care Act's (ACA) major provisions took effect in 2014. The temporary policies are typically sold to consumers who are trying to fill coverage gaps for a few months, and they are increasing despite the fact that people who buy them could face growing financial penalties. “This is exactly the kind of coverage the ACA was designed to get rid of,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. Consumer advocates say many people do not understand the downsides of the short-term policies. Penalties can skyrocket to more than $695, and in many cases, buyers could simply qualify for federal subsidies instead. Short-term plans are not considered individual health insurance and are not subject to the ACA's rules. EHealth said the number of short-term policy applicants last year was more than double the figure for 2013, and HealthMarkets Inc. found that their short-term sales were 150% higher than in 2013.

From the article of the same title
Wall Street Journal (04/10/16) Mathews, Anna Wilde
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Medicine, Drugs and Devices

Physicians’ Knowledge About FDA Approval Standards and Perceptions of the 'Breakthrough Therapy' Designation
A new study has found that physicians have poor knowledge of U.S. Food and Drug Administration (FDA) approval standards and "breakthrough therapy" designations. FDA has labeled certain drugs as "breakthroughs" since 2012, and can do so if clinical evidence suggests an advantage over existing options. It is a buzzword made for headlines, and it could be coloring physicians' perception of its actual meaning. In the study, 73 percent of physicians incorrectly believed that FDA approval meant comparable effectiveness to other drugs. Seventy percent incorrectly believed approval required both a statistically significant and clinically important effect. And 52 percent incorrectly believed that strong evidence is needed to earn the breakthrough designation. The study's authors noted that these misconceptions could lead physicians to overprescribe newly approved drugs, particularly breakthrough therapies, and to inadequately communicate how well these drugs work for the patients who will use them.

From the article of the same title
JAMA (04/12/16) Kesselheim, Aaron S.; Woloshin, Steven; Eddings, Wesley; et al.
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Reviewing Medical Device Security Guidelines
Medical device security guidelines can be hard to decipher. It is important for healthcare organizations, particularly covered entities, to focus on the essential guidelines and fully understand appropriate federal regulations. Recent guidance released by the U.S. Food and Drug Administration (FDA) is a good place to start. In the report, FDA explained that cybersecurity risk management is a shared responsibility among industry stakeholders and that the guidelines are in place to help medical device manufacturers monitor, identify and address vulnerabilities. Documentation is also a necessity, and all "methods and controls used in the design, manufacture, packaging, labeling, storage, installation and servicing of all finished devices” must be properly noted. Healthcare organizations must monitor device cybersecurity as well as adhere to all federal regulations. This means identifying "mappings" between the HIPPA Security Rule and NIST Cybersecurity Framework. This could also help organizations identify potential gaps.

From the article of the same title
HealthIT Security (04/11/2016) Snell, Elizabeth
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Senator Calls on Medtronic, FDA for Bone Graft Injury Data
U.S. Senator Al Franken has asked for detailed information about medical device company Medtronic's bone graft Infuse following a newspaper report that the company hid thousands of adverse effects linked to the product. In a Minneapolis Star Tribune article, reporters found that Medtronic studied outcomes for 3,600 patients after the product's approval and hid more than 1,000 doctor-reported events. Medtronic claimed the database of adverse events was misfiled internally and reported to the U.S. Food and Drug Administration (FDA) once it was discovered more than five years later. Franken wants Medtronic to clarify what information it gave FDA and when. Medtronic said in an email it had received Franken's letter and looked forward to discussing the issues with him. It said the newpspaper's claims were "false." Franken said the Star Tribune article suggests the nation needs a strong commitment from FDA, companies and Congress to change medical device surveillance policies and improve patient safety.

From the article of the same title
Reuters (04/13/16) Clarke, Toni
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This Week @ ACFAS
Content Reviewers

Mark A. Birmingham, DPM, AACFAS

Daniel C. Jupiter, PhD

Gregory P. Still, DPM, FACFAS

Jakob C. Thorud, DPM, MS, AACFAS

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This Week @ ACFAS is a weekly executive summary of noteworthy articles distributed to ACFAS members. Portions of This Week are derived from a wide variety of news sources. Unless specifically stated otherwise, the content does not necessarily reflect the views of ACFAS and does not imply endorsement of any view, product or service by ACFAS.

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